The Socio-Economics and Burden Impact of Rift Valley Fever in Garissa, Kenya

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Rift Valley fever (RVF) is a viral, vector borne zoonosis that has significant threat to livestock health and production and public health in Africa. Recent outbreaks have led to high livestock mortalities and human morbidity and socio economic impacts in Garissa. To assess the level of knowledge of pastoralists to causation and transmission risk factors and describe their attitude and practices in response to RVF outbreaks and management in the context of climate change shocks. To estimate the livelihood losses and burden impacts in Garissa. A population based cross sectional household survey was conducted in March 2012 and March 2013 in four hotspots. A multistage purposive sampling was used to identify 250 participants who included pastoralists, veterinary and medical personnel and livestock traders. KAP evaluation was by questionnaires in depth key informant interviews and focus group discussions. Participatory rural appraisal tools were used to assess the economic significance of the RVF outbreaks, risk factors and management costs. 185 respondents (74%) had good knowledge of RVF (symptoms scored >50%) and risk factor analysis indicated > 150 (60%) understood the consumption of meat of dead or infected animal, milk, touching aborted foetuses caused disease. Estimated lost revenue due to closure of livestock markets and bans was over Ksh.3 billion. Intervention costs and burden of the outbreaks is discussed. There is good knowledge and attitude on RVF risk, transmission and control. It re-emergence is associated with negative impacts on livelihoods and economic endpoints in Garissa.

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The Socio-Economics and Burden Impact of Rift Valley Fever in Garissa, Kenya

  1. 1. Rift Valley Fever : Socio-Economics and Burden Impact using Knowledge Attitude and Practices in Garissa, Kenya Presented at KVA Scientific Conference at Boma Hotel, Eldoret 25th April 2014 Nanyingi M O, Thumbi S M, Muchemi G M, Rashid I M, Bett B, Kiama S G and Njenga K
  2. 2. History, Etiology and Epidemiology Montgomery , 1912, Daubney 1931, Davies 1975, Jost et al., 2010  RVF viral zoonosis of cyclic occurrence(5-10yrs), described In Kenya in 1912 isolated in 1931 in sheep with hepatic necrosis and fatal abortions.  RVFV is an OIE transboundary high impact pathogen and CDC category A select agent. Etiology: Phlebovirus in Bunyaviridae (Family).  Genome: tripartite RNA segments designated large (L), medium (M), and small (S) contained in a spherical (80–120 nm in diameter) lipid bilayer.  Risk factors: Precipitation: > 600mm, flooding Altitude: <1100masl Vector +: Aedes, culicines spp NDVI: 0.1 units > 3 months Soil : Solonetz, Solanchaks, planosols  Historical Outbreaks  Epidemics in Africa and recently Arabian Peninsula; in Egypt (1977), Kenya (1997–1998, 2006-2007), Saudi Arabia (2000–2001) and Yemen (2000–2001), Sudan (2007) and Mauritania (2010)
  3. 3. Research Objectives  To assess the level of knowledge of pastoralists to causation and transmission risk factors of RVF occurrence in Garissa.  To evaluate their attitude and practices in response to RVF outbreaks and management in the context of climate change shocks.  To estimate the socioeconomic, livelihood losses and burden impacts of Rift Valley Fever in Garissa during the recent outbreak of 2006-2007.
  4. 4. Justification  Economic and Public Health significance There is significant impact on livestock and public health leading due to morbidity, mortality with interventional costs estimated at Ksh. 5 billion in Kenya. Trade and Phytosanitary (SPS) barriers. Recent RVF outbreaks in the Horn of Africa have led to decline of 2.3% of potential marketed value of cattle and 1% decline in the value of dairy and goat/sheep production and a 1% decline in the overall value of meat. Consequent export market bans to the EU and ME.
  5. 5. Kenya: RVF Geographical Distribution 2006 -2007  Geographical coverage: 29 districts > 85% in Garissa, Kilifi, Baringo, Ijara  Livestock: Mortality of $10 Million Human: 700 cases, 158 deaths. 3.4 DALYs per 1000 people Household costs of $10 for human cases Munyua et al., 2010, Data source: DVS 2014
  6. 6. Research Methodology: Study Area and Design  Garissa: 33,620km2 , 623,060 persons, 1,358,007 Livestock.  Climate: Rainfall Bimodal - MAM, OND annual av. <300-600 mm, Diurnal T° <20- 38°C Altitude 70- 400 m asl Historical OutbreakS: Epidemics in 1997–1998, 2006-2007)  Criteria: 2006-2007 village hotspots, high pop. density, urbanization, transhumance corridors
  7. 7. Study Design and Approach  Target population: Pastoralists within 2km radius of RVF “hotspot; Kept livestock > 10yrs and present during the last outbreak.  Community based cross-sectional household survey (March 2012 & 2013): Bulla unit of sampling(10-15 households) & clustering of humans Probability proportionate to size approach every tenth household in a division  Multistage sampling: consenting individuals aged ≥ 18 years living in the study area for >1 year prior to study.  Segregation according to occupation, age, gender level of education and the duration of stay.  Geomapping of 30 selected households households & recruitment 250 participants *(Pastoralists,Livestock traders/brokers,) Dohoo et al., 2003).
  8. 8. Research tools and Participatory Rural Approaches  Structured Questionnaires: 25 pretested for consistence and validity in 20 households.  Key Informant Interviews: in-depth face to face interviews to selected participants for experience and expert opinion (pastoralists, veterinary and health personnel).  Focus Group Discussions: 30 participants (20 men/10 women), 5 participants per FGD for 30 mins  Matrix and pair wise ranking and scoring: Listing of livestock diseases.  Transect walks and triangulation at livestock markets, watering points
  9. 9. Economic model for Value chain Impacts Adapted from Rich and Wanyoike 2010
  10. 10. Data Analysis  Bivariate analysis was performed to explore associations between overall knowledge and independent variables such as age, sex, marital status, education and occupation.  Associations were considered to be statistically significant if they achieved a p < 0.05.  Logistic regression models were fitted to estimate independent associations between subscale knowledge and predictor variables  Livelihood analysis for value chain by disruption of livestock markets and livelihood adaptation/diversification pathways.
  11. 11. Results : Disease Listing
  12. 12. Knowledge of clinical signs of RVF in Garissa livestock keepers  There was a positive correlation between level of education, occupation and knowledge of disease (Pearson’s correlation coefficient r2 = 0.6).  185 respondents (74%) had good knowledge of RVF (symptoms scored >50%).  Risk factor analysis indicated > 150 (60%) understood the consumption of meat of dead or infected animal, milk, touching aborted fetuses caused disease.
  13. 13. Socio_economic impacts  The minimum, average and maximum expenditure per month of livestock households during outbreak period: Ksh 5000, 10,000 and 20,000 Ksh ) US$ 1 to Ksh 85.  Mass vaccination and prophylaxis cost estimated to cost > Ksh. 1 billion to confer (70% coverage for herd immunity), RiftVax unit cost of Ksh.12per dose. (P = 0.414)  Transhumance: School droput (50%), human displacement and pastoral dropout was significant with projected economic costs of Ksh. 500 Million .  Foregone revenue due to disruption of livestock markets during the outbreak period(3 months) estimated at Ksh. 3 Billion
  14. 14. Research Gaps  Disease Burden Analysis for Zoonotic Diseases?  Lack of denominator population data of livestock causes underestimation of impact and Burden  Lack of national level estimates of socioeconomics of Zoonotic diseases.  Collaborative linkages to be strengthened in multidisciplinary groups = ZDU
  15. 15. ACKNOWLEDGEMENTS Data and Financial Support Field work facilitation  Veterinary Staff Kinyua J, Garissa Asaava LL , Fafi Obonyo M, Daadab Study Participants and NGOs  All community members in study sites Local administrators Department of Veterinary Services Contact : mnanyingi@kemricdc.org, mnanyingi@gmail.com

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